CHICAGO (Reuters) - U.S. heart experts are calling for a two-pronged approach for treating patients with chest pain or heart attacks caused by partially blocked arteries, physicians groups said on Monday.
The new guidelines, issued jointly by the American Heart Association and the American College of Cardiology, refine 2002 recommendations and suggest steps for treating patients based on better information about who might better benefit from medical versus invasive therapy.
“The guidelines are emphasizing the importance of determining risk early on in these patients and choosing the right therapy,” said Dr. Sidney Smith, a cardiologist at the University of North Carolina and a past president of the American Heart Association.
They differentiate between high-risk and low-risk patients with unstable chest pain or non-ST elevation myocardial infarction, a type of mild heart attack that does not cause changes on an electro-cardiogram.
“Medical therapy should be used in many patients with low-risk who previously might have been sent out without important attention to these therapies,” Smith said in a telephone interview.
The new guidelines suggest that stabilized and lower-risk patients get a stress test, an echo-cardiogram and other tests of heart function.
These patients also should receive a number of therapies to prevent a second heart attack, including the use of ACE inhibitors — drugs that protect the heart muscle — and other drugs. And they place greater emphasis on smoking cessation and better control of cholesterol and blood pressure.
High-risk patients will still be recommended for early intervention, such as the opening the blockages with a balloon-tipped catheter and inserting a device called a stent to keep the artery open.
Patients who receive a drug-eluting stent — which releases a drug to keep the artery open — should also receive 12 months of treatment with the anti-platelet drug clopidogrel, sold by Bristol-Myers Squibb Co. as Plavix.
The guidelines emphasize use of Plavix even among those who do not receive a stent, Smith said.
Coronary artery disease is the leading cause of death in the United States and unstable angina and non-ST elevation myocardial infarction are acute forms of this disease.